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Mental Health Status Prior to Radical Cystectomy Can Indicate Risk of Complications

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Key Points

  • Complications occur in as many of 66% of patients undergoing radical cystectomy.
  • In 274 patients who had undergone radical cystectomy and had completed the SF-12, mental components of health were statistically significantly lower in those who had a high-grade 30-day complication rate (44.8 vs 49.8, P = .004) but physical components of health were not (39.2 vs 43.8, P = .06).

A patient's mental health prior to surgery can influence postoperative outcomes. Removal of the bladder, or radical cystectomy, is an effective treatment for locally advanced bladder cancer, but complications occur in as many as 66% of patients. In a study published by Sharma et al in The Journal of Urology, researchers found that patients whose self-assessment of mental health was low suffered more high-grade complications in the 30 days following surgery than patients with higher self-assessments.

“Prior studies have suggested that poor baseline mental health can lead to more significant postoperative complications, possibly due to impaired immune response associated with higher levels of stress,” explained Scott M. Gilbert, MD, MS, of the H. Lee Moffitt Cancer Center. “This may delay both wound healing and the ability to fight infection in the postoperative state, for example. Although self-appraisal of overall well-being may mediate physiologic responses to surgery, patient-reported health status has not been extensively studied among bladder cancer patients to date, and its utility in predicting postoperative outcomes, such as complications, has not been previously examined.”

Study Findings

Using a quality-of-life survey, the Medical Outcomes Study Short Form (SF-12), patients appraised their own health and quantified the effects of disease and treatment on their overall well-being. The SF-12 is a standardized, validated questionnaire that measures composite scores for physical and mental components of health.

This study showed a relevant association between patient reported mental health status and high-grade complications after radical cystectomy for patients with bladder cancer. In 274 patients who had undergone radical cystectomy and had completed the SF-12, mental components of health were statistically significantly lower in those who had a high-grade 30-day complication rate (44.8 vs 49.8, = .004) but physical components of health were not (39.2 vs 43.8, = .06).

“Recognition of poor preoperative mental health may represent a potential signal warranting more proactive recognition and assessment preoperatively,” noted Dr. Gilbert.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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